Ohio Department of Health logo

CO21, CT20, & RC21 Survey

Please fill out this survey with information regarding your CO21, CT20, and/or RC21 grants. The purpose of this survey is to better understand your use of the funding, and assess if additional funds are needed.

Thank you for providing us with this helpful information.
1.Agency Name(Required.)
2.Total Award Amount(Required.)
3.Of the award amount, what dollar amount will not be spent/obligated by 12/30/2020? Your AWARD WILL BE REDUCED BY this amount.(Required.)
4.Reduce Personnel (Please enter the dollar amount your award will be reduced by in this area)(Required.)
5.Reduce Other Direct Costs (Please enter the dollar amount your award will be reduced by in this area)(Required.)
6.Reduce Equipment (Please enter the dollar amount your award will be reduced by in this area)(Required.)
7.Reduce Contracts (Please enter the dollar amount your award will be reduced by in this area)(Required.)
8.If the Feds offer an extension for the grants ending
12/30/20, could your agency then spend all of the funds?

Please write "Yes" or "No" for each grant.
(Required.)
9.Please enter additional funds needed for Personnel to the nearest dollar amount. 

If your agency does not need additional funding in this area, please enter "0" in each answer box.
(Required.)
10.Please enter additional funds needed for Other Direct Costs to the nearest dollar amount. 

If your agency does not need additional funding in this area, please enter "0" in each answer box.
(Required.)
11.Please enter additional funds needed for Equipment to the nearest dollar amount. 

If your agency does not need additional funding in this area, please enter "0" in each answer box.
(Required.)
12.Please enter additional funds needed for Contracts to the nearest dollar amount. 

If your agency does not need additional funding in this area, please enter "0" in each answer box.
(Required.)
13.What other concerns does your agency have with the CO21 sub-grant? If you have no concerns, please leave this question blank.
14.What other concerns does your agency have with the CT20 sub-grant? If you have no concerns, please leave this question blank.
15.What other concerns does your agency have with the RC21 sub-grant? If you have no concerns, please leave this question blank.
16.Please write any other comments here.